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LETTER TO EDITOR Table of Contents  
Ahead of print publication
Oxycodone as a replacement to opioid to facilitate tracheal intubation

 Department of Anesthesiology and Intensive Care, Faculty of Medicine, Udayana University, Denpasar, Indonesia

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Date of Submission22-Jun-2020
Date of Decision17-Jul-2020
Date of Acceptance21-Jul-2020
Date of Web Publication28-Aug-2020

How to cite this URL:
Tanggono A, Sinardja CD, Pramana Suarjaya I P. Oxycodone as a replacement to opioid to facilitate tracheal intubation. Bali J Anaesthesiol [Epub ahead of print] [cited 2021 Apr 22]. Available from: https://www.bjoaonline.com/preprintarticle.asp?id=293614

Dear Sir,

Conox's qCON algorithm (Quantium Medical, Spain) was recently available in our hospital. It assesses the level of hypnosis during sedation–analgesia. The analgesic potency between oxycodone and fentanyl showed a more extended duration of action and a better analgesic effect than fentanyl and morphine. The analgesic potency of oxycodone is about 30% greater than that of morphine and slightly longer acting than morphine. Oxycodone could minimize patient hemodynamic responses to sudden stimuli such as endotracheal intubation similar to fentanyl.

The qCON monitor processes and analyzes the electroencephalogram (EEG) changes in brain electrical activity recorded by electrodes, which is placed on the patient's forehead. They calculate a dimensionless index that reflects the hypnotic component of anesthesia by evaluating changes in the recorded EEG frequency spectrum and exploit the observation that EEG oscillations change with increasing levels of sedation.[1] Even though a direct correlation between activation and nociceptors and the sensory experience of pain is not always apparent, emotional state, degree of anxiety, attention and distraction, past experiences, memories, and other factors can either enhance or diminish the pain experience.[2]

Awareness during anesthesia is a rare event. The Conox's qCON index is modern digital technology that facilitated the application of advanced mathematics in the diagnostics and analysis equipment.[3] The efficacy of oxycodone and morphine may play an essential role in the analgesic efficacy and may be enhanced in long-term therapy. Oxycodone acts on the central nervous system via the μ-receptor and the κ-2b receptor.[4] The plasma levels of oxycodone are approximately more active than morphine. The analgesic potency of oxycodone is about 30% greater than morphine. Furthermore, it is slightly acting longer than morphine, and it does not cause histamine release.[5]

Oxycodone minimizes hemodynamic responses to sudden stimuli such as endotracheal intubation similar to fentanyl. Fentanyl, commonly administered before intubation, is a short-acting opioid, while oxycodone is a robust μ-opioid receptor agonist, and its potency is similar to morphine. The onset time of oxycodone is rapid onset time about 5–8 min.[6]

Laryngoscopy and tracheal intubation often cause tachycardia, increased blood pressure, and arrhythmias. These hemodynamic responses to tracheal intubation are associated with an increase in plasma catecholamine concentrations and are contributed by the β-adrenergic blockade.[7] In our experience, oxycodone routinely attenuates the sympathetic response during endotracheal intubation as well as provides stable blood pressure during intubation and better depth of anesthesia.[8]

Oxycodone would be beneficial in daily anesthesia practice. Further studies evaluating the depth of anesthesia quantitatively, such as using Conox'x qCON, will be required to deepen our understanding regarding this matter.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Müller JN, Kreuzer M, García PS, Schneider G, Hautmann H. Monitoring depth of sedation: Evaluating the agreement between the bispectral index, qCON and the entropy module's state entropy during flexible bronchoscopy. Minerva Anestesiol 2017;83:563-73.  Back to cited text no. 1
Suarjaya PP, Sinardja CD, Tanggono A. Oxycodone in mastectomy surgery. Bali J Anaesthesiol 2020;4:72-4.  Back to cited text no. 2
  [Full text]  
Jensen EW, Litvan H, Struys M, Martinez Vazquez P. Pitfalls and challenges when assessing the depth of hypnosis during general anaesthesia by clinical signs and electronic indices. Acta Anaesthesiol Scand 2004;48:1260-7.  Back to cited text no. 3
Lenz H, Sandvik L, Qvigstad E, Bjerkelund CE, Raeder J. A comparison of intravenous oxycodone and intravenous morphine in patient-controlled postoperative analgesia after laparoscopic hysterectomy. Anesth Analg 2009;109:1279-83.  Back to cited text no. 4
Silvasti M, Rosenberg P, Seppälä T, Svartling N, Pitkänen M. Comparison of analgesic efficacy of oxycodone and morphine in postoperative intravenous patient-controlled analgesia. Acta Anaesthesiol Scand 1998;42:576-80.  Back to cited text no. 5
Lee YS, Baek CW, Kim DR, Kang H, Choi GJ, Park YH, et al. Comparison of hemodynamic response to tracheal intubation and postoperative pain in patients undergoing closed reduction of nasal bone fracture under general anesthesia: A randomized controlled trial comparing fentanyl and oxycodone. BMC Anesthesiol 2016;16:115.  Back to cited text no. 6
Yoo KY, Lee JU, Kim HS, Im WM. Hemodynamic and catecholamine responses to laryngoscopy and tracheal intubation in patients with complete spinal cord injuries. Anesthesiology 2001;95:647-51.  Back to cited text no. 7
Park KB, Ann J, Lee H. Effects of different dosages of oxycodone and fentanyl on the hemodynamic changes during intubation. Saudi Med J 2016;37:847-52.  Back to cited text no. 8

Correspondence Address:
Aninda Tanggono,
Department of Anesthesiology and Intensive Care, Faculty of Medicine, Udayana University, Jl. Pb Sudirman, Denpasar 80232, Bali
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/BJOA.BJOA_117_20


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